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LETTER TO EDITOR
Year : 2018  |  Volume : 9  |  Issue : 1  |  Page : 40-41

Multifocal osteomyelitis involving the clavicular bones


Department of Paediatrics, Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria

Date of Web Publication24-Jan-2018

Correspondence Address:
Dr. Ibrahim Aliyu
Department of Paediatrics, Aminu Kano Teaching Hospital, Bayero University, Kano
Nigeria
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/mjmsr.mjmsr_29_17

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How to cite this article:
Aliyu I. Multifocal osteomyelitis involving the clavicular bones. Muller J Med Sci Res 2018;9:40-1

How to cite this URL:
Aliyu I. Multifocal osteomyelitis involving the clavicular bones. Muller J Med Sci Res [serial online] 2018 [cited 2020 Dec 4];9:40-1. Available from: https://www.mjmsr.net/text.asp?2018/9/1/40/223906

Dear Editor,

Osteomyelitis is an infection of the bone; this commonly involves the long bones such as that of the extremities; organisms commonly implicated are Staphylococcus aureus, Haemophilus influenzae type b, and Streptococcus pneumoniae, and in sickle-cell anemic patients,  Salmonella More Details typhi have been implicated.[1] The bacterial profile of osteomyelitis in sickle-cell disease (SCD) has changed over the years, Ebong [1] in 1986 reported Salmonella osteomyelitis in 50% of case [1] while Thanni [2] reported S. aureus as the most common organism implicated in osteomyelitis among SCA patients in Nigeria; though SCD patients have a greater susceptibility to salmonella osteomyelitis worldwide; why this is so is not completely understood, however, SCD affects the opsonization and splenic immune protective function. A 7-year-old boy presented with fever, limb, and chest pain for 10 days; he was a diagnosed sickle-cell anemic patient who had been regular with his routine drugs and he had also received his routine vaccines. These complaints were associated with the upper chest [Figure 1] and both leg swellings; there was no history of difficulty in breathing, but he had worsening limb pains with attempted ambulation. He had an elevated white blood cell count of 35 × 109/L. The X-ray of the lower limbs and clavicles showed periosteal reaction on the medial ends of both clavicles and tibia and blood culture grew S. aureus. He made remarkable improvement after 3 weeks of antibiotic therapy. Multifocal osteomyelitis is uncommon in the general populace; however, Ebong [1] reported it in 42.6% of SCD patients; the lower limbs were mostly affected with symmetrical distribution while the tibia was the most affect bone; however, involvement of the clavicles was not reported.[1] Clavicular osteomyelitis is rare;[3],[4],[5] Chrysochoou et al.[6] reported it constituting <3% of cases of osteomyelitis in children. It may follow post-traumatic events, especially after subclavian catheter placement;[5],[6] furthermore, hematogenous spread has been implicated, as was observed in the index case. Few cases have been reported among sickle-cell anemic patients,[7] and the clinical features may be quite subtle with limited X-ray findings, and S. aureus is the most implicated organism, which was similar to our findings.
Figure 1: Upper bilateral parasternal swellings

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  References Top

1.
Ebong WW. Acute osteomyelitis in Nigerians with sickle cell disease. Ann Rheum Dis 1986;45:911-5.  Back to cited text no. 1
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2.
Thanni LOA. Bacterial osteomyelitis in major sickling haemoglobinopathies: Geographic difference in pathogen prevalence. Afr Health Sci 2006;6:236-9.  Back to cited text no. 2
    
3.
Gerscovich EO, Greenspan A. Osteomyelitis of the clavicle: Clinical, radiologic, and bacteriologic findings in ten patients. Skeletal Radiol 1994;23:205-10.  Back to cited text no. 3
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4.
Balakrishnan C, Vashi C, Jackson O, Hess J. Post-traumatic osteomyelitis of the clavicle: A case report and review of literature. Can J Plast Surg 2008;16:89-91.  Back to cited text no. 4
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5.
Saglam F, Saglam S, Gulabi D, Eceviz E, Elmali N, Yilmaz M, et al. Bilateral clavicle osteomyelitis: A case report. Int J Surg Case Rep 2014;5:932-5.  Back to cited text no. 5
    
6.
Chrysochoou EA, Antachopoulos C, Badekas K, Roilides E. A rare case of clavicle osteomyelitis in a child and literature review. Case Rep Pediatr 2016;2016:8252318.  Back to cited text no. 6
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7.
Al-Fifi SH, Al-Qahtani SM, Al-Binali AM, Annobil SH. An unusual complication of sternal and clavicle osteomyelitis in a child with sickle cell disease. Saudi Med J 2002;23:589-90.  Back to cited text no. 7
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